Aspirin Resumption After Lumbar Fusion in Ischemic Heart Disease

Rationale for Early Resumption

The American College of Cardiology/American Heart Association recommends that aspirin must be continued indefinitely in all patients with established coronary artery disease, as this is a Class I recommendation, with the highest level of evidence 1, 2, 3
The American College of Cardiology/American Heart Association prefers the 81 mg daily dose of aspirin over higher maintenance doses because it provides equivalent cardiovascular protection with lower bleeding risk 1, 2, 4
Aspirin reduces serious vascular events by approximately 25% in patients with prior myocardial infarction, resulting in 36 fewer events per 1000 patients treated over 2 years, according to the American College of Cardiology 5

The American College of Cardiology/American Heart Association states that aspirin withdrawal has been associated with recurrent acute coronary syndrome events, emphasizing the need for continuous aspirin therapy in patients with ischemic heart disease 5
The American College of Cardiology/American Heart Association recommends that aspirin should never be interrupted in patients with coronary stents, as it reduces major adverse cardiac events, with a high level of evidence 3
The cardiovascular risk of perioperative myocardial infarction or stent thrombosis outweighs the risk of manageable surgical bleeding in patients with ischemic heart disease, according to the American College of Cardiology/American Heart Association 1, 3

The American College of Cardiology recommends resuming aspirin 81 mg within 24 hours after lumbar fusion surgery in patients with ischemic heart disease, as soon as the patient is hemodynamically stable and there is no evidence of active bleeding requiring surgical re-exploration, with a moderate level of evidence 6
The American College of Cardiology/American Heart Association advises that if there is concern for bleeding, the absolute maximum delay should be 48 hours postoperatively, as longer interruption significantly increases cardiovascular risk, with a high level of evidence 3, 5

The American College of Cardiology/American Heart Association suggests considering proton pump inhibitor co-therapy to reduce gastrointestinal bleeding risk, particularly in patients with a history of gastrointestinal bleeding, with a moderate level of evidence 1, 5

The American College of Cardiology/American Heart Association warns against extending aspirin interruption beyond 48 hours postoperatively in patients with ischemic heart disease, as the cardiovascular risk becomes unacceptable, with a high level of evidence 3, 5